Alcohol Use Disorder

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a long-term brain condition in which you can’t stop or control your drinking even though it’s hurting your social life, your job, or your health.

It’s a range that includes alcohol abuse, which is when drinking has serious consequences again and again. It also includes alcohol dependence or alcoholism, which is when you’ve lost control of your drinking.  Learn more about the symptoms of alcohol abuse.

How much alcohol is too much?

If you’re going to drink, experts recommend doing it “in moderation.” This means no more than one drink a day if you're a woman and no more than two if you're a man. One drink equals:

  • 1.5 ounces of liquor (like whisky, rum, or tequila)
  • 5 ounces of wine
  • 12 ounces of beer

Another way to look at your drinking habits is to think about how much you have during an average week. For women, "heavy" or "at risk" drinking means more than seven drinks per week or more than three in any day. For men, it's more than 14 drinks in a week or more than four in a day.

Alcohol Use Disorder Symptoms

An estimated 16 million people -- adults and adolescents -- in the U.S. have alcohol use disorder.

The signs of AUD can include:

  • An uncontrollable urge to drink
  • Lack of control over how much you drink
  • Negative thoughts when you're not drinking alcohol
  • Drinking in risky situations
  • Drinking that interferes with things you enjoy
  • Continuing to drink even though it causes problems or makes them worse
  • Stopping important activities or doing them less often because of alcohol

There are mild, moderate, and severe forms of AUD, which depend on how many symptoms you have. You may have AUD if one or more of these statements is true:

  • You can't relax or fall asleep without drinking.
  • You need a drink in the morning to get going.
  • To be social, you have to drink.
  • Alcohol serves as your escape from feelings.
  • After drinking, you drive.
  • You mix alcohol and medications.
  • You drink when you're pregnant or caring for small children.
  • When loved ones ask how much you drink, you don't tell the truth.
  • You hurt people or become angry when you drink.
  • It's tough for you to remember what you did when you were drinking.
  • Your responsibilities suffer because of your drinking.
  • Drinking has caused you legal problems.
  • You tried to stop drinking but failed.
  • You can't stop thinking about drinking.
  • To feel the effects of alcohol, you have to drink more and more.
  • You have withdrawal symptoms after you stop drinking for too long, like shakiness, nausea, trouble sleeping, or seizures.

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Alcohol Use Disorder Effects

Even if your case is mild, it can have a serious impact on your physical and mental health. Often, AUD causes other problems that you try to avoid by drinking. That creates a negative cycle.

In the short term, AUD can cause:

Long-term effects include:

You're also more likely to take dangerous risks. That raises your chances of being injured or dying from:

  • Car accidents
  • Homicide
  • Suicide
  • Drowning

AUD affects people around you, too. Your drinking may damage relationships with loved ones because of anger problems, violence, neglect, and abuse. Pregnant women risk having a miscarriage. Their babies are more likely to have fetal alcohol syndrome and a higher chance of sudden infant death syndrome (SIDS).

Alcohol Use Disorder Causes and Risk Factors

Different things can cause alcohol use disorder or make it more likely in different people. These include:

  • Impulsiveness
  • Low self-esteem
  • A need for approval
  • Trying to cope with emotional problems
  • Peer pressure
  • Easy access to alcohol
  • Low socioeconomic status
  • Physical or sexual abuse
  • A family history of alcohol problems
  • Regular binge drinking
  • Drinking at an early age
  • Bariatric surgery

Alcohol Use Disorder Diagnosis

Your doctor may ask about your drinking habits and want to talk with your family and friends. They might also do a physical exam and order lab tests to learn whether alcohol use is affecting your health.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders says someone has alcohol use disorder if they meet two or more of 11 criteria in one 12-month period. AUD may be mild, moderate, or severe, based on how many of the criteria are true.

The criteria are:

  • Alcohol use in larger amounts or for a longer time than intended
  • A lasting desire or unsuccessful effort to cut down or control alcohol use
  • A lot of time spent getting alcohol, drinking it, or recovering from its effects
  • A craving for alcohol
  • Alcohol use that causes a failure to meet obligations at work, school, or home
  • Alcohol use that continues even though it leads to lasting or repeated personal problems
  • Giving up or cutting back on important activities because of alcohol
  • Repeatedly using alcohol in dangerous situations
  • Using alcohol even though you know it causes physical or psychological problems, or makes them worse
  • Alcohol tolerance, when you need more to have the same effect
  • Alcohol withdrawal

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Alcohol Use Disorder Treatment

Depending on your case, you can get one or more types of treatment for alcohol use disorder. The main goal is to avoid alcohol and find a better quality of life.

You may first need to go through withdrawal. This doesn’t cause serious symptoms in most people, but they’re common in more severe cases.

Counseling and support

Therapy, whether alone or as part of a group, can help you understand your disorder and what may have caused it. You’ll get assistance staying away from alcohol and sticking with your treatment plan. The support of your loved ones is important, so they might need or want to be involved too.

Medication

If you have moderate or severe AUD, your doctor may prescribe one or more of these medications:

Residential treatment

People who have serious AUD may need to live in a treatment facility staffed by medical professionals who have experience treating the disorder. Most programs involve therapy, support groups, education, and other activities.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on August 24, 2020

Sources

SOURCES:

Mayo Clinic: “Nutrition and healthy eating: Alcohol: If you drink, keep it moderate," “Alcohol use disorder.”

American Psychological Association: “Understanding alcohol use disorders and their treatment.”

American Family Physician: “Alcohol Abuse: How to Recognize Problem Drinking.”

National Institute of Alcohol Abuse and Alcoholism: “Alcohol Use Disorder,” “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5.”

University of North Carolina at Chapel Hill Bowles Center for Alcohol Studies: “Alcoholism and Alcohol Abuse.”

CDC: “Alcohol and Public Health.”

American Academy of Family Physicians: “Alcohol Abuse.”

Medscape: “What are the DSM-5 criteria for Alcohol Use Disorder?”

UpToDate: “Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis,” “Approach to treating alcohol use disorder.”

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